Romeo Jamie L R, Papageorgiou Grigorios, van de Woestijne Pieter C, Takkenberg Johanna J M, Westenberg Lauren E H, van Beynum Ingrid, Bogers Ad J J C, Mokhles Mostafa M
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands.
Interact Cardiovasc Thorac Surg. 2018 Aug 1;27(2):257-263. doi: 10.1093/icvts/ivy057.
The objective of this study was to determine long-term results with bicuspidalized allografts compared to non-bicuspidalized allografts in children under 2 years undergoing primary correction of the right ventricular outflow tract.
Thirty-five consecutive bicuspidalized allografts were compared to 45 consecutive non-bicuspidalized allografts implanted during the same period. Valve-related events were analysed with Kaplan-Meier and Cox-regression techniques. Mixed-effects modelling was used to analyse serial echocardiographic measurements of pulmonary gradient. In addition, a systematic review with meta-analysis of the published literature concerning implantation of bicuspidalized allografts was performed.
Perioperative characteristics and in-hospital mortality [bicuspidalized 5 (14.3%), non-bicuspidalized 6 (13.3%)] were comparable (P = 0.902). Bicuspidalized allografts were smaller (14.7 vs 16.5 mm, P = 0.023) and always (100%) of pulmonary origin compared to 26 (57.8%) of the standard-sized allografts. There were no differences in late mortality between the bicuspidalized and non-bicuspidalized group (6.7% vs 7.7%, P = 0.798) or freedom from allograft replacement at 10 years (82 ± 10% and 71 ± 8%, for bicuspidalized and non-bicuspidalized allografts, respectively). Evolution of peak pulmonary gradient (P = 0.273) was comparable between bicuspidalized and non-bicuspidalized allografts. Meta-analysis showed a pooled early and late mortality for bicuspidalized allograft patients of 10.72% [95% confidence interval (CI) 6.13-18.75] and 1.6% per year (95% CI 0.99-2.79), respectively. Pooled estimated late reintervention and replacement rates were 5.94% per year (95% CI 3.42-10.30) and 3.78% per year (95% CI 2.69-5.32), respectively.
Bicuspidalization seems to be a viable alternative to combat limited supply of small-sized allografts with acceptable survival and reintervention rates comparable to non-bicuspidalized allografts.
本研究的目的是确定在2岁以下接受右心室流出道初次矫正的儿童中，与未双叶化同种异体移植物相比，双叶化同种异体移植物的长期效果。
将连续35例双叶化同种异体移植物与同期植入的45例连续未双叶化同种异体移植物进行比较。采用Kaplan-Meier法和Cox回归技术分析瓣膜相关事件。使用混合效应模型分析肺梯度的系列超声心动图测量值。此外，还对已发表的有关双叶化同种异体移植物植入的文献进行了系统评价和荟萃分析。
围手术期特征和院内死亡率[双叶化5例（14.3%），未双叶化6例（13.3%）]具有可比性（P = 0.902）。双叶化同种异体移植物较小（14.7对16.5 mm，P = 0.023），且均（100%）来自肺动脉，而标准尺寸同种异体移植物中有26例（57.8%）来自肺动脉。双叶化组和未双叶化组的晚期死亡率（6.7%对7.7%，P = 0.798）或10年时无需同种异体移植物置换的比例（双叶化和未双叶化同种异体移植物分别为82±10%和71±8%）无差异。双叶化和未双叶化同种异体移植物的肺峰值梯度变化（P = 0.273）具有可比性。荟萃分析显示，双叶化同种异体移植物患者的早期和晚期合并死亡率分别为10.72%[95%置信区间（CI）6.13 - 18.75]和每年1.6%（95% CI 0.99 - 2.79）。合并估计的晚期再次干预率和置换率分别为每年5.94%（95% CI 3.42 - 10.30）和每年3.78%（95% CI 2.69 - 5.32）。
双叶化似乎是应对小尺寸同种异体移植物供应有限的一种可行替代方法，其生存率和再次干预率与未双叶化同种异体移植物相当，可接受。
